PMT15-01354 City of Menifee Permit No.: PMT15-01354
29714 HAUN RD.
<ACCEL-A7. MENIFEE, CA 92586 Type: Commercial Electrical
MENIFEE Date Issued: 0511912015
PERMIT
Site Address: 26703 MCCALL BLVD, MENIFEE, CA Parcel Number: 335-172-009
92586 Construction Cost: $2,317.00
Existing Use: Proposed Use:
Description of METER RESET WITH 2O0AMP PANEL AND CERT OF OCC INSPECTION
Work:
Owner Contractor
UNITED CHURCH OF SUN CITY COMMON GROUND ELECTRICAL TECHNOLOGIES
26701 MCCALL BLVD INC
MENIFEE, CA 92586 P 0 BOX 955
Applicant Phone:9513264772
MENIFEE, CA License Number:970945
Fee Description ON Amount($
Meter Reset 1 116.60�'
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$144.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation, issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued.
' Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto//www,leqiofo.ca.aov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should /� j Z
subject to the workers'compensation provisions of Section 3700 of the LaborProperty �— at
Code, I shall forthwith comply with those provisions. Owner or Authorized Agent;;
City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address Li NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law forthe reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL FAEPORI'ING,
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
v
BUILDING : SAFETY PERMIT/PLAN APPLICATION
P . .
Menifee
DATE ��f/y Lv/S PERMIT/PLAN CHECK NUMBER -
TYPE: C COMMERCIAL O RESIDENTIAL C% MULTI-FAMILY $MOBILE HOME •.) POOL/SPA 0 SIGN
SUBTYPE: CC: ADDITION 0 ALTERATION '>DEMOLITION r<ELECTRICAL ^., MECHANICAL
*NEW O PLUMBING C? RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ei
- IvU7//L✓�,LS CI j�
PROJECT ADDRESS �o O /J� �' L /.�Z-'✓� R` ��a /3UJ � S/6Ct,,
ASSESSOR'S PARCEL NUMBER 33 / -7 - U lq LOT -g'� TRACT
OWNERNAME (i/m/wJl�/ /l/r G- p✓5"72T/c�� /1✓G GG. L
ADDRESS t;P—( O /'vG/ /6 s� L-
2-
PHONE SS� �� �Sy EMAIL
APPLICANT NAME //�'Z/!i✓///"/n Jvr�n/ G/ 17%/✓'�iSTl2ir3 /r✓G [j'GG
ADDRESS qt''�L�C
PHONE =js-�, (oCJz �/ 6 n EMAIL zAh4 -(4,A ,Q /30 ylyvv.6o-w
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS G�Q �Uk �/ p S//f✓�! Gam. J�2S-, � � e7YK �
PHONE Z 6 Z EMAIL C C -
CONTRACTOR'S STATE LIC NUMBER y70 LICENSE CLASSIFICATION C �P
VALUATION$ a 3 1:1 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE /&14,1/f 2-0-510TY STAFF USE ONLY
DEPARTMENT DISTRIBUTION OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP /� CITY
INVOICE PAID AMOUNT
AMOUNT <%CASH {HECK# C.'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH '0 CHECK# '{:CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED Q YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.LIS Inspection Request Line 951-246-5213
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91 of these sha11 t be t _ MR for,or arl � r
any ' k of any provis' a or city
r s and ordfnaticis. This set of must be kept on the
1 d site until completion. �ysaY�YaEi•s
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ENIFE 1 '
4 y.
Scott A. Mann
Mayor
Wallace W. Edgerton Re: Address Assignment Date: May 19, 2015
Deputy Mayor
Project: United Church of Sun City
John V. Denver Temporary Power for Modular Classrooms
Councilmember
Thomas Fuhrman
Councilmember To Whom It may Concern,
The following address has been assigned:
Greg August
Councilmember
APN Address
335-172-009 26703 McCall Blvd.
Please contact Craig Carlson at the City of Menifee if you have any questions.
C
Craig Carlson
Senior Inspector
City of Menifee
951 -672-6777 ext. 119
29714 Haun Road
Menifee,CA 92586
Phone 951.672.6777
Fax 951.69.3843
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Y�
MANUF NON-RES PERMIT
PERMIT # : BMN980001 Status : ISSUED
Job Address: 26701 MCCALL BLV SUNC Issued: 05/11/1998
Expires : 11/07/1998
Work Desc : COMMERCIAL COACH SITE PREP - CLASSROOM
Parcel No: 335-172-008
Location: TG 838/D-5
Tract/Lot : TR02846/LOT 1 Zoning:R-2-SCD
APPLICANT HIS LIGHT ON THE HILL OUTREACH Phone: 909-679-4667
MINISTRIES, 26701 MCCALL BLVD, SUN CITY CA 92381
OWNER UNITED CHURCH OF SUN CITY CALIF
26701 MCCALL AVE, SUN CITY, CA 92586
ARCHITECT RAY MARTINEZ AND ASSOCIATES Phone : 909-446-8755
ARCHITECTURE & PLANNING INC, 34590 COUNTY LINE RD, YUCAIPA CA 92
PAYEE RAY MARTINEZ & ASSOCIATES
Manufacturer: Model : Year Built : 1975
Serial # : Width: 10 Length: 52
HUD # : A-UNIT: B-UNIT: C-UNIT:
Setback-Front : 50 Left : 26 Right : 45 Rear: 5
ERBS Cert # : ERBS Model # :
,--,,- .ERBS Manuf : Brand/Model :
FEE INFORMATION
Item Description Qty Fee Amount
Issuance Fee . . . . . . . . . . . . . . . . . : 1 20 . 00
Site Prep (# Lots) . . . . . . . . . . . .. 1 35 . 00
S .M. I . Fee . . . . . . . . . . . . . . . . . . . : . 00
Microfilm Fee . . . . . . . . . . . . . . . . : . 00
Reinspections . . . . . . . . . . . . . . . . : . 00
Transfer Fee . . . . . . . . . . . . . . . . . : . 00
Renewal Fee . . . . . . . . . . . . . . . . . . : . 00
LMS Surchage . . . . . . . . . . . . . . . . . : . 83
Recording Fee . . . . . . . . . . . . . . . . : . 00
Total Calculated Fees : 55 . 83
Additional Fees : . 00
Total Permit Fees : 55 . 83
CALL FOR INSPECTION
�lequests for inspection shall be made at least
- - 24 hours in advance by telephone at (909) 694-5242
MOBILEHOME INSTALLATION ACCEPTANCE
1.D, NO.
PERMIT No.
ADDRESS OR LOCATION OF MOBILE HOME: oi�,///_
Owner's name: 4)
jI
Owner's address: 114 5 �lh
INSIGNIA OR HUD NUMBER
MANUFACTURER'S NAME:
SERIAL NUMBER OR V.1,N, 7 7 YEAR OF MANUFACTURE:
(01ficial Approving Thstallaiion) (pate) (phone)
IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL
BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOBILEHOME IS INSTALLED ON A FOUN-
DATION SYSTEM.
284-130(Rev.3182) DISTRIBUTION:WHITE-Owper,CANARY-Permittee,PINK-Office Files
MANUF NON-RES PERMIT
PERMIT # : EMN980005 Status : ISSUED
Sob Address : 26701 MCCALL AVE SUNC Issued: 05/11/1998
Work Desc: COMMERCIAL COACH SITE PREP - CLASSROOM Expires : 11/07/1998
Parcel No : 335-172-008
Location : TG 838/D-5
Tract/Lot : TR02846/LOT 1 Zoniag:R-2-SCD
APPLICANT HIS LIGHT ON THE HILL OUTREACH Phone : 909-679-4667
MINISTRIES, 26701 MCCALL BLVD, SUN CITY CA 92381
OWNER UNITED CHURCH OF SUN CITY CALIF
26701 MCCALL AVE, SUN CITY, CA 92586
ARCHITECT RAY MARTINEZ AND ASSOCIATES Phone : 909-446-3755
ARCHITECTURE & PLANNING INC, 34590 COUNTY LINE RD, YUCAIPA CA 92
PAYEE RAY MARTINEZ & ASSOCIATES
Manufacturer: Model : Year Built : 1975
Serial # : Width: 24 Length: 60
HUD # : A-UNIT: B-UNIT: C-UNIT:
Setback-Front : 50 Left : 26 Right : 45 Rear: 5
ERBS Cert # : ERBS Model # :
ERBS Manuf : Brand/Model :
� l �
FEE INFORMATION
Item Description Qty Fee Amount
Issuance Fee . . . . . . . . . . . . . . . . . : 1 20 . 00
Site Prep (## Lots) . . . . . . . . . . . : 1 35 . 00
I
S.M. I. Fee. . . . . . . . . . . . . . . . . . . : . 00
Microfilm Fee. . . . . . . . . . . . . . . . : . 00
Reinspections. . . . . . . . . . . . . . . . : . 00
Transfer Fee . . . . . . . . . . . . . . . . . : . 00
Renewal Fee. . . . . . . . . . . . . . . . . . : . 00
LMS Surchage. . . . . . . . . . . . . . . . . : . 83
Recording Fee . . . . . . . . . . . . . . . . : . 00
Total Calculated Fees : 55 . 83
Additional Fees : . 00
Total Permit Fees : 55 .83
CALL FOR INSPECTION
/�Iequests for inspection shall be made at least
,24 hours in advance by telephone at (909) 694-5242
i
MOBILEHOME INSTALLATION ACCEPTANCE
I.D. NO.
_ 1
PERMIT NO. .. k)
ADDRESSOR LOCATION OF MOMLEHOME:
Owner's name: 4/1'11(F U ('14 u/( C -' ., - - - --,-- -------- - --- -- ,i
Owner's address:
I r I,
INSIGNIA OR HUD NUMBER: S9?9
MANUFACTURER'S NAME:
� SERIAL NUMBER ORV.L�/N.�- _-- YEAR OF MANUFACTURE:
IOfllclal AOProv[nB lnsfalt abenl (eaial IPnorel
i
IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL '..
BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOBILEHOME IS INSTALLED ON A FOUN-
DATION SYSTEM.
,- 284-130(Rev.3182) DISTRIBUTION.WHfTE-Owner,CANARY-Permittee,PINK-Office Files
R
3
1J
MANUF NON-RES PERMIT
PERMIT # : BMN980003 Status : ISSUED
Job Address : 26701 MCCALL AVE SUNC Issued: 05/11/1998
Expires : 11/07/1996
Work Desc : COMMERCIAL COACH SITE PREP - CLASSROOM
Parcel No : 335-172-008
Location: TG 838/D-5
Tract/Lot : TR02846/LOT 1 Zoning:R-2-SCD
APPLICANT HIS LIGHT ON THE HILL OUTREACH Phone: 909-679-4667
MINISTRIES, 26701 MCCALL BLVD, SUN CITY CA 92381
OWNER UNITED CHURCH OF SUN CITY CALIF
26701 MCCALL AVE, SUN CITY, CA 92586
ARCHITECT RAY MARTINEZ AND ASSOCIATES Phone : 909-446-8755
ARCHITECTURE & PLANNING INC, 34590 COUNTY LINE RD, YUCAIPA CA 92
PAYEE RAY MARTINEZ & ASSOCIATES
Manufacturer: Model : Year Built : 1975
Serial # : Width: 10 Length: 52
HUD # : A-UNIT: B-UNIT: C-UNIT:
Setback-Front : 50 Left : 26 Right : 45 Rear: 5
j ERBS Cert #: ERBS Model # :
n ERBS Manuf : Brand/Model :
FEE INFORMATION
Item Description Qty Fee Amount
Issuance Fee. . . . . . . . . . . . . . . . . : 1 20 . 00
Site Prep (# Lots) . . . . . . . . . . . : 1 35 . 00
I.
S.M. I . Fee. . . . . . . . . . . . . . . . . . . : . 00
Microfilm Fee . . . . . . . . . . . . . . . . : . 00
Reinspections . . . . . . . . . . . . . . . . : 60 . 00
Transfer Fee . . . . . . . . . . . . . . . . . : . 00
Renewal Fee . . . . . . . . . . . . . . . . . . : . 00
LMS Surchage . . . . . . . . . . . . . . . . . : 1 . 73
Recording Fee. . . . . . . . . . . . . . . . : . 00
Total Calculated Fees : 116 . 73
Additional Fees : . 00
Total Permit Fees: 116 . 73
CALL FOR INSPECTION
( '?equests for inspection shall be made at least
24 hours in advance by telephone at (909) 694-5242
I
MOBR EHOME INSTALLATION ACCEPTAI'l
1.D. NO.
PERMIT NO.
LADDRESS OR LOCATION OF MOBILEHOME:
Owner's name: �,Il le, hv A' C
Owner's address: 54
INSIGNIA OR HUD NUMBER:
MANUFACTURER'S NAME:
SERIAL NUMBER OR VJLi YEAR OF MANUFACTURE:
12.
(Official Approving installallon) r-rTPh.1a)
IF THE MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION ACCEPTANCE SHALL
BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE MOBILEHOME IS INSTALLED ON A FOUN-
DATION SYSTEM.
284-130(Rev.3182) DISTRIBUTION:WHITE-Owner,CANARY-Permittee,PINK-Office Files